Longitudinal Study of Postpartum Cardiovascular Function in HDP Patients

The following is a summary of “Postpartum cardiovascular function in patients with hypertensive disorders of pregnancy: a longitudinal study,” published in the SEPTEMBER 2023 issue of Obstertrics and Gynecology by Giorgione, et al.

Women who have experienced hypertensive disorders of pregnancy face an elevated risk of cardiovascular diseases, often driven by the emergence of cardiovascular risk factors like chronic hypertension, metabolic syndrome, or subclinical myocardial dysfunction. Recent evidence suggested that these cardiovascular risk factors can develop soon after pregnancy. For a study, researchers sought to evaluate the persistence of hypertension and myocardial dysfunction in a group of women with hypertensive disorders of pregnancy at 4 months postpartum. Additionally, they aimed to compare echocardiographic parameters between the peripartum (the period immediately before or after childbirth) and the postpartum period.

In a longitudinal prospective study, they recruited a cohort of women with preterm or term hypertensive disorders of pregnancy. They also included an unmatched group of women with term normotensive pregnancies. This hypertensive disorders of pregnancy cohort contained women with preexisting chronic hypertension. All participants underwent two cardiovascular assessments: the first was conducted either before delivery or within 1 week of delivery (V1: peripartum assessment), and the second occurred between 3 and 12 months after delivery (V2: postpartum assessment). The cardiovascular evaluation encompassed a blood pressure profile, maternal transthoracic echocardiography (which looked at various heart parameters), and a metabolic assessment. Echocardiographic data were compared between V1 and V2 in both the hypertensive disorders of pregnancy group and the control groups.

Out of 260 patients with pregnancies complicated by hypertensive disorders of pregnancy and 33 patients with normotensive pregnancies, 219 (84.2%) and 30 (90.9%) respectively attended postpartum follow-up. The postpartum assessment occurred at a median of 124 days (interquartile range, 103–145) after delivery. Paired comparisons of echocardiographic findings revealed significant improvements in various cardiac indices, including cardiac remodeling rates (left ventricular mass index [g/m2], 63.4±14.4 vs 78.9±16.2; P<.001; relative wall thickness, 0.35±0.1 vs 0.42±0.1; P<.001), diastolic indices (E/e’, 6.3±1.6 vs 7.4±1.9; P<.001), ejection fraction (ejection fraction <55%, 9 [4.1%] vs 28 [13.0%]; P<.001), and global longitudinal strain (−17.3±2.6% vs −16.2±2.4%; P<.001). The improvements were observed in both groups (hypertensive disorders of pregnancy and normotensive). At the postnatal evaluation, however, 153 of 219 (69.9%) showed either hypertension (76/219; 34.7%) or an abnormal global longitudinal strain (125/219; 57.1%), 13 of 67 (19.4%) had metabolic syndrome, and 18 of 67 (26.9%) displayed insulin resistance.

While there was persistent cardiovascular impairment in a significant portion of the patients, cardiac modifications due to pregnancy-related overload and hypertension were more pronounced during the peripartum period than in the postpartum period. The study highlighted the importance of monitoring and addressing cardiovascular health in women with a history of hypertensive disorders of pregnancy beyond the immediate postpartum period.

Source: ajog.org/article/S0002-9378(23)00166-7/fulltext